REFERENCE NOTES FOR WEIGHT REDUCTION ALGORITHM

Note 1 - Body Mass Index

BMI is a useful tool, but it des have its limitations, for example it takes no account of variations in peoples stature, frame or body composition. BMI is not accurate for children, people over 60 years, athletes or those with distorted fluid balance.

Waist circumference
BMI also gives no indication of fat distribution. It therefore fails to highlight the level of centralised or upper body fat, carries an increased risk of CHD are not highlighted . Using a tape measure, measure the mid- way point between the last rib and the top of the hipbone.

Reference ranges:

Note 2 - Is the patient motivated to change?

If the answer is yes to more than two of these, this indicates positive motivation:

• Did the patient approach you about losing weight?
  
• Have they already tried to lose weight through dieting and / or exercise?
  
• Have they have already lost weight?
  
• Do they express a positive attitude towards weight loss?
  
• Are they able to discuss positive changes that they have already made?

Note 3 - Benefits/Need for Change

Is the patient fully aware of the consequences of not making any lifestyle changes? Sometimes it may be a question of timing, especially if the diagnosis is new and the patient has many issues to deal with e.g. medication.

Note 4 - Provide Written Information on Healthy Eating

A photocopiable resource is included in the A photocopiable resource is included in the Healthy Eating chapter. Alternatively, contact the Health Promotion Library (resources are available in languages other than English, e.g. Bengali and Turkish). Telephone: 020 7530 3947. See also the BDA Weight Wise website (www.bdaweightwise.com) designed to support individuals to achieve and maintain a healthy weight.

Note 5 - Food Diary

It doesn't matter how this information is recorded i.e. in a notebook or diary - as long as the information is collected for the next appointment.

The patient should complete the food diary for a minimum of 4 consecutive days between appointments. Include portion sizes, method of cooking e.g. 2 slices of toast, half a tin of baked beans. Include all food and drink. Explain to the patient that it is vital to be open and honest otherwise you will not be able to help them to make positive changes. The act of recording food and drink is in itself a good exercise for the patient, as it makes them aware of exactly what they are eating/drinking.

Activity Diary
Record journeys walked or cycled, gardening, any forms of exercise e.g. swimming. Also time spent inactive (watching TV/ sat at computer).

Note 6 - Reviewing the Diary

A completed diary is a good indicator of motivation and commitment. Look through the meals, drinks and snacks and discuss with the patient where they think their diet can be improved. Be cautious of a diary that is 'too good' - it may be missing a few things! Compare with the healthy eating guidelines in the 'Eating for a Healthy Heart' section.

Note 7 - Setting Goals

To ensure success, especially in the early stages, the goals must be attainable e.g. have breakfast at least twice a week / have chips only once a week/ get off the bus one stop before and walk to work / find out the nearest leisure centre and what it offers. Small successful steps will encourage commitment and eventually weight loss.

Aim for a 10% weight loss over 6 months. See the Healthy Eating and Physical Activity sections of this resource when setting goals with patients.

Note 8 - Continuing the Diary

This is a useful monitoring tool for both the patient and practitioner. It needn't be done every day, but a couple of days a week can highlight general patterns.

Note 9 - Physical Activity Programmes

All patients should be motivated to be more active, however some would benefit from more structured programmes. This may also help those who have a reasonably good diet but still find it hard to loose weight. Please see the Service Directory and/or 'Physical Activity' section for further details. LINK.

Note 10 - Referring to the Dietitian

Only patients that are well motivated will benefit from further specialist advice. Patients should be seen within 6 weeks of referral. Referral procedures will vary depending on the PCT arrangements. Please refer to the Service Directory for more details

Note 11 - Group based sessions

Becoming more available throughout the NHS - particularly to deal with the behavioural aspects of weight loss. Service details and referral procedures can be found in the Service Directory.

Note 12 - Commercial Slimming Groups

Can offer an optional extra to treatment, if the diet is based on healthy eating principles. However diets based on liquid meal replacements and/or herbal supplements are not recommended. There is often a considerable cost involved, which some people may not be able to afford and this must be considered.

Note 13 - Practice Nurse Referral to the GP

May be required for more complex cases. For example with uncontrolled/ undiagnosed conditions including mental illness or for further investigations.

May be required for more complex cases. For example with uncontrolled/ undiagnosed conditions including mental illness or for further investigations. The GP may consider pharmacological treatment, for which there are specific prescribing guidelines. Current treatments included orlistat (Xenical®) a non-systemic drug that stops fat absorption in the gut; and sibutramine (Reductil®) a systemic appetite suppressant (hence has more patient contra-indications).